PNHP

Medicare-for-all option would cover everyone, reduce costs

Medicare-for-all option would cover everyone, reduce costs

By DR. THOMAS CLAIRMONT
New Hampshire Union Leader
Friday, Aug. 21, 2009

Speaker Pelosi has pledged to hold a floor debate and vote on single-payer health reform this fall. This vote on an amendment to HR 3200 (the 1,000-plus page bill favored by the House leadership) would substitute the 27-page HR 676 as the new health care policy of the United States.

This is good news after months of suppression of a bill that should be the gold standard for comparison of plans. This is important to everyone because passage would bring simplicity and stability into your health care planning.

For about 4.5 percent of income, matched by your employer, you would receive a lifetime policy with no co-payments, no deductibles, no out-of-pocket expenses and, most important, no pre-existing conditions exclusions. Your policy would cover your choice of physician and appointments with them, hospital care, diagnostic imaging, laboratory tests, prescriptions, vision care, preventive care, dental care, chiropractic care, emergency care and ambulance transportation, podiatry, speech, physical and occupational therapy, mental health care, substance abuse care, health education, hospice care, adult day care, skilled nursing care, long-term care and dialysis. This policy would be portable, continuous and never could be canceled regardless of your employment status.

Please note that passage of this plan covers everyone with the same basic policy. Medicaid would be eliminated; Medicare would be considerably improved. Medical bankruptcy would be eliminated, and the President’s goals of universal, affordable, choice and cost controls would be met. the dreaded doughnut hole in Medicare D would be an unpleasant memory.

Costs would be contained by dramatically reducing administrative expenses, global budgeting, bulk purchasing of prescription drugs, medical supplies and equipment, mandating transparency in pricing and reducing fraud. No other plan has cost controls built in and, therefore, would be much more expensive.

Although the President keeps saying you can keep the insurance you have, it is the small businessman buying this policy for you. And with insurance premiums rising every year way above the inflation rate, providing this coverage for many is not possible anymore. A fixed percentage of payroll would be a much more affordable option.

The city of Portsmouth paid $9,615 for a family policy in 2000, and this year it’s $24,145, representing 10 percent of the property tax bill. Without reform, similar increases of this magnitude would lead to a premium of $60,362 in 2020 and $150,906 in 2030. This clearly demonstrates the need for reform.

Doctors are complaining about insurance company interference with their practice of medicine and the paperwork related to this oversight. This is minimally present in Medicare today and would disappear in the single-payer program.

Please visit Physicians for a National Health Program’s Web site, pnhp.org, for more information. Don’t discount the Medicare-for-all option without a full understanding of this program. Our principles are automatic enrollment, comprehensive coverage, public financing, eliminating administrative waste, maximum choice of physician and hospital, and delivery through a nonprofit, privately controlled system. What does your ideal system look like?

Don’t be put off by the lies and distortions blaring across your radio and television. HR 676 covers you for life; it is affordable; and it is simple to understand and implement. And it pays for itself. What does your plan do?

Dr. Thomas Clairmont is an internist in Portsmouth.

http://www.unionleader.com/article.aspx?headline=Thomas+Clairmont%3A+Medicare-for-all+option+would+cover+everyone%2C+reduce+costs&articleId=f5d7482a-0000-4e2e-b508-0179b265ca68

Beware health-industrial complex

By Jack Bernard
Opinion – Voices
Ledger-Inquirer (Columbus, Ga.)
Sunday, Aug. 23, 2009

Virtually all national polls show that health care reform is in trouble, just as it was under the Clintons. Once again, lobbyists from the health industrial complex have purposefully confused the American public, as they did with the misleading but highly effective “Harry and Louise” ads in the 1990s, and bought off our elected representatives in both parties.

I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission. Under our two-party system, it is easy to see why we Republicans oppose Democratic Party reform proposals. We are the opposition party and do not want them to get the political credit for solving a nasty problem. After all, some Democrats did the same thing when Richard Nixon wanted national health insurance.

Opposition to reform was not right then and it is not right now (20,000 Americans die each year because they do not have health insurance), but in the cynical world of politics, it is understandable. I guess what gets me is why Democrats do not support their own leadership.

Since the Democrats are in the driver’s seat, it is up to them to lead and bring their stragglers in line. However, the Democrats are fighting internally, failing to articulate a straightforward vision of the future or even one bill (Obamacare, if you will). Democratic leaders talk about access, but Blue Dog conservatives talk about cost, all the while receiving tremendous donations from health-related businesses. Insurance companies are buying them to prevent cutting costs via a public plan option or single payer, clearly the best way to cut costs.

Republican pundits are sitting back and chuckling, as they always do when reform is mentioned, and repeating the same self-serving platitudes: “If we only had tort reform all our problems would be solved.” Like it is just coincidence that trial lawyers happen to be one of the Democrats’ largest contributors! And how, exactly, does cutting down on unnecessary tests lead to more of the 50 million uninsured people getting coverage? But remember, this is politics and we must do what is right for the party, not the nation.

What amazes me is that no one is calling these individuals to account. In my view, it is unpatriotic to continue to lie to the American public about the situation facing us. Over the last 10 years, wages have gone up by about one-fourth. Health insurance premiums have gone up well over 100 percent. We cannot continue along this path to fiscal destruction. Inaction is not an option.

It is also against American values to mislead the public into believing that everyone can get good care even if they do not have insurance. The mark of a great nation is not how well it treats its privileged, but rather how well it treats its downtrodden. On this measure, we fail miserably; strange for a nation that prides itself on being the most religious democracy in the world. Where in the Bible did Jesus say “might makes right” or “those with the gold rule”?

Very few health or insurance professionals advocate for a single-payer system, the best way to control costs and ensure access. I hear all sorts of reasons: rationing (really, like HMOs do not do that now), paperwork (apparently insurance company bureaucracy does not count), socialism (come on — practitioners will still be independent and we all know it) and so forth. It is rare that we hear the underlying cause openly stated: greed. It will cut my income.

The members of Physicians for a National Health Plan are an exception to this rule. If you take a look at their Web site, www.pnhp.org, the rationale for a single-payer system is clearly articulated. The French have the top system in the world, with something like Medicare covering 66 percent of costs and private insurance for the rest, yet their cost per capita is half of ours. Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.

The problem is not technical; it is political. It is high time we put the country ahead of ourselves and establish a single-payer system.

Jack Bernard is CEO of Monticello (Ga.) Health Care Solutions and a former chairman of the Jasper County Commission and the Jasper County Republican Party.

Healthcare insurers get upper hand

Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza.'

By Tom Hamburger and Kim Geiger
LA Times
August 24, 2009

Reporting from Washington — Lashed by liberals and threatened with more government regulation, the insurance industry nevertheless rallied its lobbying and grass-roots resources so successfully in the early stages of the healthcare overhaul deliberations that it is poised to reap a financial windfall.

The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers — many of whom would get government subsidies to help pay the companies’ premiums.

“It’s a bonanza,” said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama’s massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski said the industry’s reaction to early negotiations boiled down to a single word: “Hallelujah!”

The insurers’ success so far can be explained in part by their lobbying efforts in the nation’s capital and the districts of key lawmakers.

The bills vary in the degree to which they would empower government to be a competitor and a regulator of private insurance. But analysts said that based on the way things stand now, insurers would come out ahead.

“The insurers are going to do quite well,” said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. “They are going to have this very stable pool, they’re going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide — plus their administrative costs.”

One of the Democratic proposals that most concerns insurers is the creation of a “public option” insurance plan. The industry launched a campaign on Capitol Hill against it, grounded in a study published by the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group. The lobbyists contended that a government-run plan, which would have favorable tax and regulatory treatment, would undermine private insurers.

Opposition increased this month when boisterous critics mobilized at town hall meetings held by members of Congress home for the August recess. The attacks, supplemented by conservative critics on talk radio and other forums, drew national attention.

Leading insurers, including UnitedHealth, urged their employees around the country to speak out. Company “advocacy hot line” operations and sample letters and statements were made available to an army of insurance industry employees in nearly every congressional district.

Some insurers supplemented the effort with local advertising, often designed to put pressure on specific members of Congress. Late in the spring, Blue Cross Blue Shield of North Carolina — the home state of several conservative Blue Dog Democrats — prepared ads attacking the public option.

Leading Democrats have fought back, with House Speaker Nancy Pelosi (D-San Francisco) last month calling the industry “immoral” for its past treatment of customers and suggesting insurers were “the villains” in the healthcare debate.

Still, recent support for the public option has declined, and the stock prices of health insurance firms have been rising.

Undermining support for the public option wasn’t the only gain scored by insurance lobbyists.

In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders’ medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients’ healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.

Most group health plans cover 80% to 90% or more of a policyholder’s medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans.

“It is vital that individuals, families and small-business owners have the flexibility to choose an affordable coverage option that best meets their needs,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying shop.

Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families.

“These are a bad deal for consumers,” said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America.

Meanwhile, companies would probably see a benefit by providing less insurance “per premium dollar,” Hunter said.

“It would be quite a windfall,” said Wendell Potter, a former executive at Cigna insurance company who has become an industry whistle-blower.

Consumer and labor advocates acknowledged the industry’s lobbying success.

In the first half of 2009, the health service and HMO sector spent nearly $35 million lobbying Congress, the White House and federal healthcare offices, according to data from the Center for Responsive Politics.

With more than 900 lobbyists, that sector — whose top spenders are insurance giants UnitedHealth, Blue Cross Blue Shield and Aetna — was poised to spend more than in 2008, a record lobbying year.

UnitedHealth spent the most, $2.5 million in the first half of 2009, and hired some of Washington’s most prominent political players, including Tom Daschle, the former Senate majority leader who served as an informal health policy advisor to Obama.

“They have beaten us six ways to Sunday,” said Gerald Shea of the AFL-CIO. “Any time we want to make a small change to provide cost relief, they find a way to make it more profitable.”

tom.hamburger@latimes.com

Driving a Stake Through a Bad Health Policy's Heart

By David Moberg
In These Times
Aug. 21, 2009

In last year’s presidential race, Barack Obama scored points when he attacked John McCain for proposing to tax people’s employer-provided health insurance as income. Conservatives argued that the business tax deduction for health insurance distorted healthcare markets, encouraging people to overconsume healthcare.

That assumes people are doing the equivalent of choosing extra colonoscopies over a vacation at the beach. It was bad policy and bad politics.

Then, in their destructive confusion over health reform, some Democrats–especially in the Senate–began reviving McCain’s idea, and even the administration signaled openness to it. Democrats were seeking money to pay for their proposal, and some argued that current tax subsidies favored “gold-plated” policies for high-income executives, thus making a tax on benefits progressive. Strong criticism from liberals and unions has for now beat back the plan as bad politics.

Now Harvard physicians David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health plan, have shown that the supposedly progressive rationale for taxing employer-provided health insurance is as flawed as the conservative justification.

In an article online in The New England Journal of Medicine, they show that a tax on benefits would be regressive, taking a far higher percentage of income from low- and moderate-income taxpayers than from high-income individuals.

In absolute dollar terms, the affluent gain more, but as a percentage of income, lower-income earners receive a greater benefit and thus their tax rate–if benefits were taxed–would be higher. That’s the usual definition of tax regressivity.

For example, Himmelstein and Woolhandler calculate that the mean (or average) benefit for families earning $10,000 to $19,999 and receiving employer-paid coverage is $2,115, or 13.9 percent of their income. But families earning $100,000 or more receive a mean tax benefit of $4,498, or just 2.7 percent of their income.

Of course, lower-income families are less likely to have employer-provided insurance (13.8 percent of those earning $10,000 to $19,999 compared to 61.8 percent of those earning $100,000 or more).

So when Himmelstein and Woolhandler mapped the effects of a benefit tax on the whole population, not just those whose employers provided insurance, the mean tax rate for low-income families was low, rising to a peak for middle-income families, then falling back down for the more affluent. It was still basically regressive.

They calculated the effects assuming families paid the tax, but Himmelstein says most analysts assume that if employers were taxed instead, they would simply deduct the cost from wages. If insurers were taxed, their likely strategy is less clear, but they would probably raise rates for everyone.

If only high-priced policies were taxed, people living in states with higher medical costs would be penalized, and without indexing of the cut-off for inflation, more families would be affected each year. Also, Himmelstein says, federal law generally requires employers to offer the same benefit package to all employees. So lower-paid workers at an employer (like Harvard) with comprehensive health benefits would be hit, not just high earners.

Although the plan to tax benefits now seems off the table, Himmelstein expects it to spring up again. “We’re hoping,” he says, “to drive a small stake through its heart.”

http://inthesetimes.com/working/entry/4793/putting_a_stake_through_the_heart_of_bad_health_policy/

"Mad as Hell Doctors" Embark on Cross Country Care-A-Van to Demand Single-Payer from Congress

Published by PR Web August 14, 2009 Portland, OR

Frustrated with the health care ‘options’ coming out of Washington, D.C., six “Mad as Hell” Oregon physicians are taking an unprecedented road trip across America to lobby Congress for a single-payer health care system.

Called a “Care-A-Van,” these road-tripping Oregon physicians will leave in a used motor home from Portland, Oregon on September 8th, inviting doctors and ordinary citizens from other states to join them on their twenty-city tour across the country. Their journey will culminate in a D.C.-based event on September 30th, scheduled to take place on the steps of Congress. Demonstrating with the doctors will be thousands of fellow ‘Mad as Hell’ single-payer advocates, all adorned with the movement’s new symbol – the white ribbon. Their demand: Single-Payer Now!

“We’re mad as hell because our health care system is run by people who profit from illness” says Dr. Paul Hochfeld, lead Mad As Hell Doctor and producer of the documentary ‘Health, Money and Fear.’ “The rest of the civilized world has test driven single payer and it works. But elected officials in America won’t even allow a discussion.”

“The public option is a trap.” Hochfeld continues. “It sounds very reasonable, but the problem with it, no matter what the final bill looks like, is that it will continue to allow private medical insurance companies to dictate America’s public health policies. And that’s just plain wrong.”

Several national, single-payer advocacy organizations including Physicians for a National Health Program, Health Care Now, Single Payer Action, and even groups like Progressive Democrats of America and Jobs with Justice are supporting the Oregon physicians by setting up Mad as Hell Town Halls across the country in anticipation of their arrival. “People need to understand what single-payer is–and isn’t,” says Dr. Mike Huntington, a radiologist from Corvallis, Oregon and fellow Mad As Hell Doctor. “It isn’t Socialism, any more than police and fire are Socialism. And it doesn’t require any more money. Simply put, single-payer is a way to take current premium payments that go to a thousand different private insurance companies, and redirect them into a single, public fund that insures everyone. That’s all it is. But when we do this, lots of wonderful things happen, not the least of which is to save Americans 500 billion dollars a year starting day one. That’s billion – with a ‘b.’ America needs this information. That’s why we’re taking the tour.”

Reality Television meets Political Activism

Every move the Mad as Hell Doctors make will be recorded on camera and then edited and uploaded to the Internet that same day. The uploaded segments will appear on social networking web sites such as Facebook, Twitter, YouTube, MySpace, et al, making the Mad As Hell Doctors Tour the first of its kind: an unprecedented hybrid of reality television and political activism.

“We’re doing this because we care,” declares Dr. Gene Uphoff, a family physician from Portland, Oregon and fellow Mad As Hell Doctor. “The time to demand that a Single Payer Plan be put on the table is now. We may not get another opportunity for real change like this in our lifetime. Washington needs to hear all of us right now.”

Hochfeld agrees. “This isn’t a campaign. It’s a movement. Join us.”

For more information log on @ http://www.MadAsHellDoctors.com

CONTACT: Adam Klugman 503.706.2006 adam (at) MadAsHellDoctors (dot) com visit my website www.michaelmunk.com

T.R. Reid’s “The Healing of America”

The Healing of America

A Global Quest for Better, Cheaper, and Fairer Health Care

By T.R. Reid

My global quest demonstrated that America’s approach to health care is unique in the world for a good reason: No other country would dream of doing things the way we do. So it’s clear that we can’t fix the basic problems by tinkering at the margins of our existing system. Any proposal for “reform” that continues to rely on our fragmented structure of overlapping and often conflicting payment systems for different subsets of the population will not reduce the cost or complexity of American health care. Any proposal that sticks with our current dependence on for-profit private insurers – corporations that pick and choose the people they want to cover and the claims they want to pay – will not be sustainable.

To put it simply, the United States does well when it comes to providing medical care, but has a rotten system for financing that care. We need a health care system that permits the strong facets of American medicine to flourish, makes their benefits accessible to everybody, and does it in a cost-efficient way. As we’ve seen, this is not impossible. All other rich countries have found financing mechanisms that cover everybody and they still spend much less than we do. We’ve ignored those foreign models, partly because of “American exceptionalism” – the notion that the United States has nothing to learn from the rest of the world. In health care, at least, that old mindset is clearly losing its sway. Americans are coming to realize that the other rich countries are getting more and better medicine, for less money, than we do.

Another reason Americans tend to ignore the valuable lessons we could take from the rest of the world is that we have been in thrall to conventional wisdom about health care overseas. Thus we conclude that the foreign approaches would never work here. In fact, as I found on my global quest, much of this conventional wisdom is wrong. A lot of what we “know” about other nations’ approach to health care is simply myth.

The Healing of America:
http://us.penguingroup.com/nf/Book/BookDisplay/0,,9781594202346,00.html?The_Healing_of_America_T.R._Reid

And…

5 Myths About Health Care Around the World

By T.R. Reid
The Washington Post
August 23, 2009

1. It’s all socialized medicine out there. (Not so.)

2. Overseas, care is rationed through limited choices or long lines. (Generally, no.)

3. Foreign health-care systems are inefficient, bloated bureaucracies. (Much less so than here.)

4. Cost controls stifle innovation. (False.)

5. Health insurance has to be cruel. (Not really. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit.)

All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.

(T.R. Reid, a former Washington Post reporter, is the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” to be published August 24.)

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

Comment:

By Don McCanne, MD

In “The Healing of America” and in last year’s PBS Frontline presentation, “Sick Around the World,” T.R. Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States.

Other nations have adopted one of a few rational models of health care financing, though with variations. The basic models are Bismarck (Germany, France, Belgium, Switzerland, Japan), Beveridge (Great Britain, Italy, Spain, most of Scandinavia), and national health insurance (Canada, Taiwan, South Korea).

The United States has combined these models into our patched-together system of financing health care. Our components are Bismarck (employer-sponsored plans), Beveridge (VA, Indian Health Service), and national health insurance (Medicare). But we’ve added one more model that Reid discusses: out-of-pocket for the uninsured (Cambodia, Burkina Faso, rural India, rural China). Reid makes a strong case that this dysfunctional, fragmented financing system is in a large part responsible for our very expensive mediocrity.

Which model for the United States?

The out-of-pocket model is certainly not suitable, and the Beveridge model would have very little support only because Americans are uncomfortable with the concept of government ownership of the health care delivery system.

National health insurance, based on an improved model of Medicare, would be very popular once established, and would enable us to reach our goal of affordable, high-quality care for everyone. It is the least expensive, most equitable, most efficient, and most effective model of reform.

T.R. Reid and others such as Uwe Reinhardt believe that Americans are more likely to support the Bismarck model based on private health plans. But they emphasize that our U.S. plans with a business mission would have to be transformed into European-style plans with a service mission. The superficial similarities between the U.S. and European private insurers belie the stark differences in their missions. Just imagine the probability of the highly-compensated U.S. insurance executives and the institutional investors that own their companies stepping up to lead this essential transformation. Fat chance. It is difficult to share the faith that T.R. Reid and Uwe Reinhardt have in the insurers doing the right thing.

But the biggest problem is not with the private insurers; it’s with Congress. They have decided to move forward with our patched-together system, primarily by expanding the use of U.S.-style, business-model private plans. We will be forced to use inadequate subsidies to purchase private plans that are too expensive and that provide inadequate protection in the face of medical need. This is a program that will expand expensive mediocrity – hardly the solution we seek.

An improved Medicare for all is what America would really want, if only the people were better versed in policy science. It’s our job to see that they become so.

(T.R. Reid will be a featured speaker at the PNHP Annual Meeting in Cambridge, MA on Saturday, October 24. Meeting information is available on the PNHP website at www.pnhp.org).

Where’s the Wizard of Oz When We Need Him?

By Carol Miller
Taos Daily News
August 15, 2009

The people are crying-out for access to health care. The economy is in freefall with no sign yet of the bottom. It is time for bold action. Poll after poll finds that two out of every three Americans supports converting to a universal health care system similar to Medicare.

I find myself wishing there was someone like the Wizard of Oz to give courage to politicians, the courage to stand up for us–the people, the taxpayers, the voters.

So, what’s the problem?

One problem is that most elected leaders, from the president on down, are cowards when it comes to standing up to the corporations. A few recent examples: bailouts for banks while homeowners still face foreclosure and homelessness; the AIG mega-insurance corporate bailout; and the current and most cruel bailout–protecting large sickness insurance corporations rather than giving us guaranteed access to health care. This is not reform.

A truly reformed system would focus on improving health by expanding public health, prevention, wellness programs, and easy access to health care without causing fear as to how individuals will pay for it.

It is becoming obvious that there is more interest in raising current and future campaign funds than giving us access to the higher quality, lower-cost health care that the rest of the industrialized world enjoys.

How much money has corporate health care invested in politicians to protect their profits? In the past 10 years, a cool $3.4 billion. 2008 was a big investment year for health corporations: $167 million to Congressional candidates (60% to Democrats), $18.7 million to the Obama Campaign, and $7.3 million to McCain. While that sounds like a lot to us, it is pocket change for these corporations–they make billions in profit every year.

A Billion Dollars a Day

I know there are a lot of numbers in this commentary, but if you want to memorize only one, here it is: health insurance administrative costs alone waste one billion dollars a day, $365 billion dollars a year, and a trillion dollars every two and a half years. This is a trillion dollars that are sucked out of the health care system every couple of years for wasteful paperwork and corporate profit. Not one penny of this provides any health care. This is why the corporations are fighting to have the 49 million uninsured handed over to them.

Elected Politicians are Helping Government Haters Kill Health Reform

When our elected officials refuse to strongly defend the popular, lifesaving and well-run government health programs, they open the door and airways to endless government bashing. We see now how out of control these government haters have become. Some of these are even the people we have elected to represent us!

Why won’t the president stand up and defend government health programs? He has had so many opportunities, but instead he plays into the hands of the sickness insurance corporations, feeding the myth that people like their insurance companies.

U.S. Socialized Medicine Is Popular

Americans are so trained to think that socialized anything is bad that they get frightened when they hear lies in the media that the government is going to impose socialized medicine. The definition of socialized medicine is when the government owns the hospitals and clinics and all of the staff are government employees.

This system actually sounds very familiar to 20 million Americans, and almost one out of every four New Mexicans. You know why? The United States already has a very large socialized medical system that includes military health, veteran’s health, and the Indian Health Service.

Why doesn’t President Obama ever mention this? He could let people know that the VA is a great system, recently honored as having the highest patient satisfaction of all health plans for the sixth year in a row. The military has always had a socialized health system, and service members consider it the most important benefit of service.

America Already Has a Single Payer System

It is amazing that the thought of government-run health care frightens so many people, including those who already have it. The United States today has the largest single payer health care system in the world, with 103 million beneficiaries–more than one out of every three Americans.

In New Mexico, 800,000 people have single payer health care, through Medicare and Medicaid. Add in the more than 400,000 in the socialized system, and two out of every three New Mexicans is already in government run health care. The truth is, most of them like it and are more satisfied with their coverage and care than people in corporate sickness insurance.

Here is why Medicare is popular–it keeps the private delivery system intact and leaves it to the government to pay the bills. If people want “choice,” they will find more choice of doctors and hospitals in Medicare than any other insurance plan.

The president has said time and again that if we were starting the system from scratch, he would favor a single payer system. He is clear that he knows it is the best. But he always follows this up with the comment that a lot of people like what they have, so we will build on the current system. But 123 million people already have government health care, 41% of the country. Why not get to universal health care by building on these systems?

At a recent AARP Forum on Health Reform, President Obama was unable to convince a Medicare beneficiary that Medicare is actually a government-run program. The person refused to believe that the government could operate such a great program.

Rather than standing up for the government, the president missed the perfect opportunity to educate and move the country. He could have explained that reform will not be about taking away anything from the 45 million seniors in Medicare, but instead would welcome their children and grandchildren to join them in the most popular government program.

Compare that to the current system which has grandma in Medicare, mom and dad either uninsured or in another plan, and often the children in yet another, each with annual enrollment, changing rules, and benefits unknown until you are sick and an insurance company bureaucrat tells your doctor what care you can get. Imagine the whole family in one health system, with the same rules, benefits, and enrollment for life–this is an idea worth fighting for!

People Like Their Insurance?

Really? Who are these people? This is a huge lie. The president says it over and over. Our members of Congress say it over and over, but repeating this lie will never make it true.

For the most part, people like their doctors and the hospitals and clinics where they get care, but in my many years of working in health care, I have never met anyone who told me they love their insurance company.

Insurance companies collect money every month, supposedly to pay for health care, but their profits are based on denying and rationing as much care as possible. The rationing starts before someone even signs up for an insurance plan, because sales agents are trained to discourage or deny coverage to sick people or people who they think might become sick.

With corporate for-profit insurance, you never know in advance what will be paid for and how much they will leave for you to pay. Too many people have learned the absolute heartlessness of ruthless insurance companies. More than 500,000 people in the United States go bankrupt every year as a result of medical bills or illness. Most who declare medical bankruptcy are “insured,” or so they thought. They paid their premiums every month, but when they or a family member became sick, they learned that they were not protected from financial ruin.

Who benefits from this system? Insurance executives and CEOs with sky-high compensation packages reaching to the tens and hundreds of millions of dollars. The former CEO of United Health Care holds the record, receiving over one billion dollars in a single year in salary and stock options. This is the same corporation that just “won” the contract to run the behavioral health system in the State of New Mexico.

Continuing the for-profit sickness insurance industry and using tax dollars to expand it further is yet another unaffordable corporate bailout. This is a nonessential industry that makes profits from rationing health care to people who need it and, even worse, it rations the care to people who have already paid for it!

My challenge to the New Mexico Congressional delegation and the president is this: even if you don’t have the courage to support a transformation of the health care system that would let everyone into a restored Medicare program, why not at least let the 49 million uninsured enroll in this most popular government program? This is the easiest and least costly way to cover the uninsured.

There are two bills in Congress to create a Medicare-for-All program, House Bill 676 and Senate Bill 703. On July 30th, U.S. House of Representatives Speaker and California Congresswoman Nancy Pelosi committed to a vote on HB676 when Congress comes back from vacation in September.

The outcome of that vote depends on us making sure that all of our representatives know we oppose the looming corporate bailout and want health care, not health insurance.

What we want is simple: one system, everyone in, nobody out.

Driving a Stake Through a Bad Health Policy’s Heart

By David Moberg
In These Times
Aug. 21, 2009

In last year’s presidential race, Barack Obama scored points when he attacked John McCain for proposing to tax people’s employer-provided health insurance as income. Conservatives argued that the business tax deduction for health insurance distorted healthcare markets, encouraging people to overconsume healthcare.

That assumes people are doing the equivalent of choosing extra colonoscopies over a vacation at the beach. It was bad policy and bad politics.

Then, in their destructive confusion over health reform, some Democrats–especially in the Senate–began reviving McCain’s idea, and even the administration signaled openness to it. Democrats were seeking money to pay for their proposal, and some argued that current tax subsidies favored “gold-plated” policies for high-income executives, thus making a tax on benefits progressive. Strong criticism from liberals and unions has for now beat back the plan as bad politics.

Now Harvard physicians David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health plan, have shown that the supposedly progressive rationale for taxing employer-provided health insurance is as flawed as the conservative justification.

In an article online in The New England Journal of Medicine, they show that a tax on benefits would be regressive, taking a far higher percentage of income from low- and moderate-income taxpayers than from high-income individuals.

In absolute dollar terms, the affluent gain more, but as a percentage of income, lower-income earners receive a greater benefit and thus their tax rate–if benefits were taxed–would be higher. That’s the usual definition of tax regressivity.

For example, Himmelstein and Woolhandler calculate that the mean (or average) benefit for families earning $10,000 to $19,999 and receiving employer-paid coverage is $2,115, or 13.9 percent of their income. But families earning $100,000 or more receive a mean tax benefit of $4,498, or just 2.7 percent of their income.

Of course, lower-income families are less likely to have employer-provided insurance (13.8 percent of those earning $10,000 to $19,999 compared to 61.8 percent of those earning $100,000 or more).

So when Himmelstein and Woolhandler mapped the effects of a benefit tax on the whole population, not just those whose employers provided insurance, the mean tax rate for low-income families was low, rising to a peak for middle-income families, then falling back down for the more affluent. It was still basically regressive.

They calculated the effects assuming families paid the tax, but Himmelstein says most analysts assume that if employers were taxed instead, they would simply deduct the cost from wages. If insurers were taxed, their likely strategy is less clear, but they would probably raise rates for everyone.

If only high-priced policies were taxed, people living in states with higher medical costs would be penalized, and without indexing of the cut-off for inflation, more families would be affected each year. Also, Himmelstein says, federal law generally requires employers to offer the same benefit package to all employees. So lower-paid workers at an employer (like Harvard) with comprehensive health benefits would be hit, not just high earners.

Although the plan to tax benefits now seems off the table, Himmelstein expects it to spring up again. “We’re hoping,” he says, “to drive a small stake through its heart.”

http://inthesetimes.com/working/entry/4793/putting_a_stake_through_the_heart_of_bad_health_policy/

“Mad as Hell Doctors” Embark on Cross Country Care-A-Van to Demand Single-Payer from Congress

Published by PR Web August 14, 2009 Portland, OR

Frustrated with the health care ‘options’ coming out of Washington, D.C., six “Mad as Hell” Oregon physicians are taking an unprecedented road trip across America to lobby Congress for a single-payer health care system.

Called a “Care-A-Van,” these road-tripping Oregon physicians will leave in a used motor home from Portland, Oregon on September 8th, inviting doctors and ordinary citizens from other states to join them on their twenty-city tour across the country. Their journey will culminate in a D.C.-based event on September 30th, scheduled to take place on the steps of Congress. Demonstrating with the doctors will be thousands of fellow ‘Mad as Hell’ single-payer advocates, all adorned with the movement’s new symbol – the white ribbon. Their demand: Single-Payer Now!

“We’re mad as hell because our health care system is run by people who profit from illness” says Dr. Paul Hochfeld, lead Mad As Hell Doctor and producer of the documentary ‘Health, Money and Fear.’ “The rest of the civilized world has test driven single payer and it works. But elected officials in America won’t even allow a discussion.”

“The public option is a trap.” Hochfeld continues. “It sounds very reasonable, but the problem with it, no matter what the final bill looks like, is that it will continue to allow private medical insurance companies to dictate America’s public health policies. And that’s just plain wrong.”

Several national, single-payer advocacy organizations including Physicians for a National Health Program, Health Care Now, Single Payer Action, and even groups like Progressive Democrats of America and Jobs with Justice are supporting the Oregon physicians by setting up Mad as Hell Town Halls across the country in anticipation of their arrival. “People need to understand what single-payer is–and isn’t,” says Dr. Mike Huntington, a radiologist from Corvallis, Oregon and fellow Mad As Hell Doctor. “It isn’t Socialism, any more than police and fire are Socialism. And it doesn’t require any more money. Simply put, single-payer is a way to take current premium payments that go to a thousand different private insurance companies, and redirect them into a single, public fund that insures everyone. That’s all it is. But when we do this, lots of wonderful things happen, not the least of which is to save Americans 500 billion dollars a year starting day one. That’s billion – with a ‘b.’ America needs this information. That’s why we’re taking the tour.”

Reality Television meets Political Activism

Every move the Mad as Hell Doctors make will be recorded on camera and then edited and uploaded to the Internet that same day. The uploaded segments will appear on social networking web sites such as Facebook, Twitter, YouTube, MySpace, et al, making the Mad As Hell Doctors Tour the first of its kind: an unprecedented hybrid of reality television and political activism.

“We’re doing this because we care,” declares Dr. Gene Uphoff, a family physician from Portland, Oregon and fellow Mad As Hell Doctor. “The time to demand that a Single Payer Plan be put on the table is now. We may not get another opportunity for real change like this in our lifetime. Washington needs to hear all of us right now.”

Hochfeld agrees. “This isn’t a campaign. It’s a movement. Join us.”

For more information log on @ http://www.MadAsHellDoctors.com

CONTACT: Adam Klugman 503.706.2006 adam (at) MadAsHellDoctors (dot) com visit my website www.michaelmunk.com

Uwe Reinhardt on the public option

Who Needs the Public Option?

By Uwe Reinhardt
The New York Times
August 21, 2009
Nothing has been quite as riveting in recent media reports as the question of what President Obama and his staff really think…
How did the brouhaha over the choice of a public health plan come about in the first place, when the real issue before us has been helping the millions of currently uninsured, low-income American families gain access to adequate and reliable health insurance?
One would have hoped that the overarching goal of health reform would have been to put in place a reformed health insurance system that can offer Americans the same reliable, permanent, portable and life-cycle health insurance enjoyed by, say, Germans or Canadians or the people of Japan and Taiwan.
As I have argued in earlier posts to this blog, the choice of a public, government-run standard health insurance plan would certainly go a long way toward reaching that, but it is not a necessary condition for doing so. Germany, the Netherlands and Switzerland all do offer their citizens permanent, portable and stable financial security in health care without the inclusion of a government-run health plan in the mix. That achievement, however, requires fairly heavy regulation of the industry.
If I had to guess what features really make a public plan so attractive to many Americans, they would probably be the stability, permanence, portability and simplicity that such a public plan could offer. It is these features that make traditional, government-run Medicare so popular with the public.
Herein lies the main challenge facing the private health insurance industry. It must convince the public and the legislators who do not trust it that with the help of government — including a wide set of new government regulations — the industry can transform itself into a structure that can offer Americans the same permanent, reliable, easy-to-understand life-cycle financial security that citizens in other nations take for granted and Americans crave.
Thus, instead of the cliche that a public health plan would lead to a “government takeover of American health care” and thus its demise, the industry would be better advised to put before the public a fully worked out purely private-sector model that truly will offer individuals reliable, life-cycle health insurance with relatively stable premiums, and at premiums that are defensible.
http://economix.blogs.nytimes.com/2009/08/21/who-needs-the-public-option/

Posted comment by Don McCanne, MD:
The brouhaha over the public option is more than just symbolic. The accusation is correct: the public option was perceived as a means to move us toward single payer, while respecting the right of others to continue with their current coverage if they so preferred. The progressive camp was divided over this strategy since some of us believed that jettisoning single payer in favor of the public option would result in a bargaining position in which the public option would have to be traded away in exchange for some insurance market reforms. Those single payer advocates who agreed to support the public option now feel betrayed.
But the much more important goal is to establish a system that prevents financial hardship for anyone who needs health care – a system of social insurance, whether that is based on single payer or on a system of highly regulated private plans, as some European nations have.
Congress is trying to patch together a model based on private plans, but they have run up against a uniquely American problem – our very high health care costs. The average health care cost far a healthy family of four (the healthy workforce and their young healthy families) is now $16,771. With a typical family income of $60,000, generous subsidies will be mandatory for middle-income individuals and families.
We already have hit the wall on costs. Congress is proposing basic coverage (tier one) that has an actuarial value of 65 to 70 percent, leaving those with significant health care needs exposed to the balance of the costs (which is often higher than the stop loss because of the failure of our private insurance model to protect individuals from unanticipated out-of-network charges). Average-income individuals who need care will not be able to afford the out-of-pocket costs.
Even for those who remain healthy, our costs are now so high that a plan with reasonable benefits that would provide adequate financial protection in the event of need must charge premiums that are so high that a generous public subsidy is essential. The wall again – Congress is unwilling to use aggressive, progressive tax policies to pay for subsidies that are large enough to keep premiums affordable for average-income individuals.
There is an out. Congress will waive the fine for the criminal act of being uninsured merely because the premium is unaffordable. The standard “coverage” for the middle-income sector will then be “hardship waivers” (assuming a transition away from employer-sponsored coverage – the intent of many members of Congress). The only other option besides aggressive tax policies would be to make the basic plan so Spartan that it won’t provide adequate financial protection anyway. (Don’t say high deductible plans, because if the deductible is high enough to make the premium affordable, the plans do not provide adequate protection for middle-income individuals and families.)
The real problem with the public option concept is that it automatically leaves in place the most expensive and least efficient method of financing health care. A single payer or improved Medicare for all would provide us with more than simply an equitable and efficient method of financing care for everyone, it would also create our own public monopsony so that we can demand greater value from our health care system.